Download PDF
Endoscopy 2008; 40(12): 1026-1032
DOI: 10.1055/s-0028-1103414
Total Barrett Eradication review section

© Georg Thieme Verlag KG Stuttgart · New York

Argon plasma coagulation, bipolar cautery, and cryotherapy: ABC's of ablative techniques

J.  A.  Dumot1 , B.  D.  Greenwald2
  • 1Department of Gastroenterology and Hepatology, Cleveland Clinic, Cleveland, Ohio, USA
  • 2Division of Gastroenterology and Hepatology, Department of Medicine, University of Maryland School of Medicine and Greenebaum Cancer Center, Baltimore, Maryland, USA
Further Information

Publication History

Publication Date:
08 December 2008 (online)

Also available at
    Permissions and Reprints

A variety of endoscopic ablation modalities are available for the treatment of Barrett’s esophagus. Multiple studies have evaluated the use of argon plasma coagulation, mostly in nondysplastic Barrett’s esophagus. Significant variations in technique, end points, and follow-up exist between studies, but in most cases argon plasma coagulation is associated with unacceptable rates of persistent intestinal metaplasia and recurrence after completion of treatment. In addition, serious adverse events including perforation and stricture formation are reported. Multipolar electrocoagulation has been studied less thoroughly, but in prospective trials significant rates of persistent and recurrent intestinal metaplasia have also been reported. Lasers and heater probes have been tried in small numbers. Endoscopic cryotherapy ablation is a relatively new technique with studies focusing on high-grade dysplasia and early-stage cancer in high-risk patients. It has an acceptable safety profile, and early results show response in a significant number of patients in whom other modalities have failed.

References

  • 1 Berenson M M, Johnson T D, Markowitz N R. et al . Restoration of squamous mucosa after ablation of Barrett’s esophageal epithelium.  Gastroenterology. 1993;  104 1686-1691
    PubMedSearch in Google Scholar
  • 2 Manner H. Argon plasma coagulation therapy.  Curr Opin Gastroenterol. 2008;  24 612-616
    CrossrefPubMedSearch in Google Scholar
  • 3 Bright T, Watson D I, Tam W. et al . Randomized trial of argon plasma coagulation versus endoscopic surveillance for Barrett’s esophagus after antireflux surgery: late results.  Ann Surg. 2007;  246 1016-1020
    CrossrefPubMedSearch in Google Scholar
  • 4 Dulai G S, Jensen D M, Cortina G, Fontana L. Randomized trial of argon plasma coagulation vs. multipolar electrocoagulation for ablation of Barrett’s esophagus.  Gastrointest Endosc. 2005;  61 232-240
    CrossrefPubMedSearch in Google Scholar
  • 5 Ferraris R, Fracchia M, Foti M. et al . Barrett’s oesophagus: long-term follow-up after complete ablation with argon plasma coagulation and the factors that determine its recurrence.  Aliment Pharmacol Ther. 2007;  25 835-840
    CrossrefPubMedSearch in Google Scholar
  • 6 Madisch A, Miehlke S, Bayerdorffer E. et al . Long-term follow-up after complete ablation of Barrett’s esophagus with argon plasma coagulation.  World J Gastroenterol. 2005;  11 1182-1116
    PubMedSearch in Google Scholar
  • 7 Manner H, May A, Miehlke S. et al . Ablation of nonneoplastic Barrett’s mucosa using argon plasma coagulation with concomitant esomeprazole therapy (APBANEX): a prospective multicenter evaluation.  Am J Gastroenterol. 2006;  101 1762-1769
    CrossrefPubMedSearch in Google Scholar
  • 8 Mörk H, Al-Taie O, Berlin F, Kraus M R, Scheurlen M. High recurrence rate of Barrett’s epithelium during long-term follow-up after argon plasma coagulation.  Scand J Gastroenterol. 2007;  42 23-27
    CrossrefPubMedSearch in Google Scholar
  • 9 Schulz H, Miehlke S, Antos D. et al . Ablation of Barrett’s epithelium by endoscopic argon plasma coagulation in combination with high dose omeprazole.  Gastrointest Endosc. 2000;  51 659-663
    CrossrefPubMedSearch in Google Scholar
  • 10 Sharma P, Wani S, Weston A P. et al . A randomised controlled trial of ablation of Barrett’s oesophagus with multipolar electrocoagulation versus argon plasma coagulation in combination with acid suppression: long term results.  Gut. 2006;  55 1233-1239
    CrossrefPubMedSearch in Google Scholar
  • 11 Van Laethem J L, Cremer M, Peny M O. et al . Eradication of Barrett’s mucosa with argon plasma coagulation and acid suppression: immediate and mid term results.  Gut. 1998;  43 747-751
    PubMedSearch in Google Scholar
  • 12 Attwood S E, Lewis C J, Caplin S. et al . Argon beam plasma coagulation as therapy for high-grade dysplasia in Barrett’s esophagus.  Clin Gastroenterol Hepatol. 2003;  1 258-263
    CrossrefPubMedSearch in Google Scholar
  • 13 Pereira-Lima J C, Busnello J V, Saul C. et al . High power setting argon plasma coagulation for the eradication of Barrett’s esophagus.  Am J Gastroenterol. 2000;  95 1661-1668
    PubMedSearch in Google Scholar
  • 14 Ragunath K, Krasner N, Raman V S. et al . Endoscopic ablation of dysplastic Barrett’s oesophagus comparing argon plasma coagulation and photodynamic therapy: a randomized prospective trial assessing efficacy and cost-effectiveness.  Scand J Gastroenterol. 2005;  40 750-758
    CrossrefPubMedSearch in Google Scholar
  • 15 Kovacs B, Chen Y, Lewis T S. et al . Successful reversal of Barrett’s esophagus with multipolar electrocoagulation despite inadequate acid suppression.  Gastrointest Endosc. 1999;  9 547-553
    PubMedSearch in Google Scholar
  • 16 Montes C, Brandalise N, Deliza R. et al . Antireflux surgery followed by bipolar electrocoagulation in the treatment of Barrett’s esophagus.  Gastrointest Endosc. 1999;  50 173-177
    CrossrefPubMedSearch in Google Scholar
  • 17 Sampliner R E, Fennerty B, Garewal H S. Reversal of Barrett’s esophagus with acid suppression and multipolar electrocoagulation: preliminary results.  Gastrointest Endosc. 1996;  44 532-535
    PubMedSearch in Google Scholar
  • 18 Sharma P, Bhattacharyya A, Garewal H S, Sampliner R E. Durability of new squamous epithelium following endoscopic reversal of Barrett’s esophagus.  Gastrointest Endosc. 1999;  50 159-164
    CrossrefPubMedSearch in Google Scholar
  • 19 Sampliner R E, Faigel D, Fennerty B. et al . Effective and safe endoscopic reversal of nondysplastic Barrett’s esophagus with thermal electrocoagulation combined with high-dose acid inhibition: a multicenter study.  Gastrointest Endosc. 2001;  53 554-558
    CrossrefPubMedSearch in Google Scholar
  • 20 Arnott J. Practical illustrations of the remedial efficacy of a very low or anaesthetic temperature.  Lancet. 1850;  2 257-259
    PubMedSearch in Google Scholar
  • 21 Allington H V. Liquid nitrogen in the treatment of skin diseases.  Calif Med. 1950;  72 153-155
    PubMedSearch in Google Scholar
  • 22 Cooper I, Lee A. Cryostatic congelation: a system for producing a limited controlled region of cooling or freezing of biological tissue.  J Nerv Ment Dis. 1961;  133 259-263
    PubMedSearch in Google Scholar
  • 23 Pasricha P J, Hill S, Wadwa K S. et al . Endoscopic cryotherapy: experimental results and first clinical use.  Gastrointest Endosc. 1999;  49 627-631
    CrossrefPubMedSearch in Google Scholar
  • 24 Kalloo A. Colon – cryotherapy for radiation proctitis. The DAVE Project 2006 Available from: http://daveproject.org/viewfilms.cfm?film_id = 378. Accessed: 21 October 2008
    Search in Google Scholar
  • 25 Kantsevoy S V, Cruz-Correa M R, Vaughn C A. et al . Endoscopic cryotherapy for the treatment of bleeding mucosal vascular lesion of the GI tract: a pilot study.  Gastrointest Endosc. 2003;  57 403-406
    CrossrefPubMedSearch in Google Scholar
  • 26 Canto M I, Dunbar K B, Okolo P. et al . Low flow CO2-cryotherapy for high risk Barrett’s esophagus (BE) patients with high grade dysplasia and early adenocarcinoma: a pilot trial of feasibility and safety [abstract].  Gastrointest Endosc. 2008;  67 AB179
    CrossrefPubMedSearch in Google Scholar
  • 27 Johnston M H. Cryotherapy and other newer techniques.  Gastroint Endosc Clin N Am. 2003;  13 491-501
    CrossrefPubMedSearch in Google Scholar
  • 28 Baust J G, Gage A A. The molecular basis of cryosurgery.  BJU Int. 2005;  95 1187-1191
    CrossrefPubMedSearch in Google Scholar
  • 29 Gage A A, Baust J. Mechanisms of tissue injury in cryosurgery.  Cryobiology. 1998;  37 171-186
    CrossrefPubMedSearch in Google Scholar
  • 30 Eastone J A, Horwhat J D, Haluska O. et al . Cryoablation of swine esophageal mucosa: a direct comparison to argon plasma coagulation (APC) and multipolar electrocoagulation (MPEC).  Gastrointest Endosc. 2001;  53 A3448
    PubMedSearch in Google Scholar
  • 31 Johnston M H, Schoenfeld P, Mysore J, Dubois A. Endoscopic spray cryotherapy: a new techique for mucosal ablation in the esophagus.  Gastrointest Endosc. 1999;  50 86-92
    CrossrefPubMedSearch in Google Scholar
  • 32 Johnston M, Eastone J A, Horwhat J D. et al . Cryoablation of Barrett’s esophagus: a pilot study.  Gastrointest Endosc. 2005;  62 842-848
    CrossrefPubMedSearch in Google Scholar
  • 33 Dumot J A, Vargo J J, Zuccaro G, Rice T W. Preliminary results of cryotherapy ablation for esophageal high grade dysplasia (HGD) or intra-mucosal cancer (IMC) in high risk non-surgical patients.  Gastrointest Endosc. 2007;  65 AB110
    PubMedSearch in Google Scholar
  • 34 Cash B D, Johnston L R, Johnston M H. Cryospray ablation (CSA) in the palliative treatment of squamous cell carcinoma of the esophagus.  World J Surg Oncol. 2007;  5 34
    CrossrefPubMedSearch in Google Scholar
  • 35 Greenwald B D, Cash B D. Cryotherapy ablation of early stage esophageal cancer.  Gastrointest Endosc. 2007;  65 AB276
    PubMedSearch in Google Scholar
  • 36 Greenwald B D, Horwhat J D, Abrams J A. et al . Endoscopic cryotherapy ablation is safe and well-tolerated in Barrett’s esophagus, esophageal dysplasia, and esophageal cancer.  Gastrointest Endosc. 2008;  67 AB76
    PubMedSearch in Google Scholar
  • 37 Gossner L, May A, Stolte M. et al . KTP laser destruction of dysplasia and early cancer in columnar-lined Barrett’s esophagus.  Gastrointest Endosc. 1999;  49 8-12
    CrossrefPubMedSearch in Google Scholar
  • 38 Sharma P, Jaffe P E, Bhattacharyya A, Sampliner R E. Laser and multipolar electrocoagulation ablation of early Barrett’s adenocarcinoma: long-term follow up.  Gastrointest Endosc. 1999;  49 442-446
    CrossrefPubMedSearch in Google Scholar
  • 39 Lightdale C J, Heier S K, Marcon N E. et al . Photodynamic therapy with porfimer sodium versus thermal ablation therapy with Nd:YAG laser for palliation of esophageal cancer: a multicenter randomized trial.  Gastrointest Endosc. 1995;  42 507-512
    CrossrefPubMedSearch in Google Scholar
  • 40 Wang K K, Lutzke L, Borkenhagen L. et al . Photodynamic therapy for Barrett’s esophagus: does light still have a role?.  Endoscopy. 2008;  40 1021-1025
    Thieme ConnectPubMedSearch in Google Scholar
  • 41 Michopoulos S, Tsibouris P, Bouzakis H. et al . Complete regression of Barrett’s esophagus with heat probe thermocoagulation: mid-term results.  Gastrointest Endosc. 1999;  50 165-172
    CrossrefPubMedSearch in Google Scholar

B. D. GreenwaldMD 

Division of Gastroenterology and Hepatology

22 South Greene Street, Rm N3W62
Baltimore
MD 21201–1595
USA

Fax: +1-410-3288315

Email: bgreenwa@medicine.umaryland.edu